2. Mailing / Billing Address

3. Shipping Address

Check here if the shipping address is the same as the mailing address shown above.

This Is A

Street Address*

Address2

City*

Country*

State | Province*

Zip Code*

Phone Number*

Fax Number

4. Disclaimer

I agree that goods purchased from , will be resold by me in the form of tangible personal property.It is understood that I am required by Sales and Use Tax law to report and pay tax, measured by the purchase price of such goods.